Single-payer healthcare is a ‘tough sell’ as California faces a massive budget deficit

(Max Whittaker/For The Times)

Single-payer healthcare is a ‘tough sell’ as California faces a massive budget deficit

Politics, health and welfare in California

Anabel Sosa

February 21, 2024

California Assembly Speaker Robert Rivas is questioning the latest proposal to create a state-run, single-payer health care system. He says he likes the idea but isn’t convinced the state can afford it, despite a budget deficit of at least $38 billion. .

The concept of single payer and expanding access and affordability are good ideas,” said Rivas, a Democrat from Hollister.

said to told

reporters at the Capitol


Wednesday. “I say this with great respect to stakeholders and advocates: We need to see how this is funded. It’s a good idea, but it’s a tough sell, especially in the budget environment we’re experiencing now.”

Assembly Bill 2200


called Guaranteed Healthcare for All

or CalCare

would establish a universal, single-payer health care system for all California residents. Assemblymember Ash Kalra’s (D-San Jose) bill builds on his previous single-payer legislation, which failed to gain enough votes to advance in January 2022.

A legislative analysis of that bill estimated the cost at between $314 billion and $391 billion in state and federal funds, an amount greater than the entire state budget Newsom proposed for the 2024-2025 fiscal year: $291.5 billion .

Legislature analysts have not yet made a decision

price tag

for Kalra’s new bill. He says it differs from his previous effort because it establishes an advisory committee, explicitly mentions gender-affirming care and comprehensive reproductive care as benefits, requires an investment in the recruitment and retention of health care workers to meet demand for services, and ensures that physicians are represented on the CalCare board.

Facing pressure from progressive activists and a politically engaged nurses’ union that has pushed for single-payer health care, California lawmakers have tried to overhaul the state’s health care system about a dozen times over the years.

The proposals tend to be divisive among Democrats and die due to concerns about costs, opposition from private insurers and the complex bureaucracy underlying the nation’s health care system.

Last year, Governor Gavin Newsom signed a bill that would pave the way for universal health care by helping California obtain a waiver from the federal government to use Medicaid and Medicare funds for a possible single-payer system. was intended as an incremental step to address some of the logistical hurdles that had hindered previous proposals for major reforms.

The California Nurses Assn., a staunch supporter of single-payer health care, opposed Wiener’s bill, expressing skepticism about whether it would help create a single-payer system or simply facilitate an iteration of universal health care.

which they say are different systems. A single-payer system means that the public receives health insurance through a centralized payer, usually through a government. Universal coverage generally refers to ensuring that all residents have coverage through both public and private systems.

Speaking to reporters, Rivas reiterated his concerns about the budget deficit.

Rivas mentioned Newsom’s budget


The $38 billion projection is more optimistic than the Legislative Analysts Office’s, but the states are not

a partisan body that advises the Legislature, which had forecast nearly $68

billion deficit in December. It updated its estimate Tuesday to peg the shortfall at about $73

million billion

. The figures are estimates based in part on projections of future revenues.


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